Provider Demographics
NPI:1619310299
Name:FUENTES, KRIZIA ELAINE
Entity Type:Individual
Prefix:MISS
First Name:KRIZIA
Middle Name:ELAINE
Last Name:FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CALLE CERRA
Mailing Address - Street 2:CDT DR. GUALBERTO RABELL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-5104
Mailing Address - Country:US
Mailing Address - Phone:787-480-3827
Mailing Address - Fax:787-721-3207
Practice Address - Street 1:900 CALLE CERRA
Practice Address - Street 2:CDT DR. GUALBERTO RABELL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-5104
Practice Address - Country:US
Practice Address - Phone:787-480-3827
Practice Address - Fax:787-721-3207
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other